If physician performs repair of recurrent incarcerated ventral hernia (49566) and then reinforces using the old mesh can he bill 49568 also? I'm not a general surgery coder so thanks for any advice or guidance anyone can give.
Also, what would be the ICD-10 code for "Sigmoid colon adherent to old mesh"?
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Can someone tell me if A0433 (ALS2) includes the cost of the required 3 drugs? We have an EMS service that keeps billing the drugs under code A0394 which is for IV drug disposable supplies. They also usually always bill 5 units of IV administration under the A0394 also. If they're supposed to bill the drugs separate, my understanding is that they should be billing with the appropriate j-code and NDC#. How would the IV hydration get billed?
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Are the X modifiers required now? I've been advise to code as follows when patient received IV Remicade and Joint injection. Many times we have patients that receive Dexamethosone as well. Please see example. How would you code this?
99213-25
20610 LT
J1040
J1745
96413-59
96415
96375-XU
J1100
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Good Morning Everyone,
I have an anesthesia provider who has been asked to provide anesthesia services in an office setting. This provider is wanting to know if he can bill for his supplies (Propofol, saline, IV tubing) as he purchases all of the supplies himself. Everything I have read states that the supplies are included in the reimbursement of the anesthesia procedure. Has anyone seen or heard anything different? If so, can you please send me the info so that I may share it with my provider?
Thanks for the help!
Scarlet
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Hello - My company is currently using a Claim Scrubber Product from OPTUM (Claims Manager). We want to review other Claim Scrubber products to determine if we should continue with our current product or find a product that better suits our needs. Our Practice Management product is GE Centricity Business and the Product would need to integrate with our TES (Transaction Editing System) application so the billing could be scrubbed prior to creating an 837. Can anyone recommend a Claim Scrubber product that will interface with Centricity Business at the TES Level? Is there any Claim Scrubber Products you would recommend to stay away from?
Thanks,
Tyra
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A patient presented in the ED with a dislocated hip. Moderate sedation (99143) was used to put the patients hip back in place. Medicare is rejecting the code stating that it is invalid. I looked the code up in the Medicare fee schedule and it has a status indicator of N which states that it is a none covered service. What do I do next? Should the charge be removed?
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Since I'm new to coding OB/GYN, I was looking for guidance on which category to use for coding deliveries when the baby is breech.
O32 category is Maternal Care for malpresentation of fetus and O64 is Obstructed labor due to malposition and malpresentation of fetus?
Any input would be much appreciated, thank you
Jaime
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Our family practice clinic draws lab and sends it out to an independent Lab to be performed. For commercial insurance payers we bill the lab CPT code with a 90 modifier we are questioning what the correct place of service would be? Would we use place of service 81-Independent lab or 11-Office?
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I was wondering if someone could point me in the right direction to find a list of covered dx for CPT code 93923. We were sent an order for the LEA test with the dx of PAD. My doctor doesn't think that is a covered dx, but I think it is. I want to double check.
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Good morning!!! I have been working for the last 45 minutes on this procedure and i am not getting anywhere. I am the lead coder for a small radiology practice where we just bill for the reading of the procedures he performs. For some reason i can't get the 32555 thoracentisis paid for. Any and all suggestions will be appreciated!
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Hello All,
A client is reaching out and would like help understanding how Objective 10 impacts Cardiology specialists. From my understanding this is related to reporting up to public health.
Not sure if there is different criteria for Cardiology as what would they be reporting up?
Any help would be appreciated.
Thank you
Confused!!!!!
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Hello Fellow Coders
I need some assistance with cross walking CPT codes. It was suggested that these codes below are ok to crosswalk one for one. However, I am not an expert in E&M coding. It was my understanding that many of these codes are not meeting the components. I understand it is ok to down code but some of these cross walks would cost the client revenue. It would be my suggestion to select coding based on what is documented. I under stand that Medicare does not pay for consults and we need to have a cross walk. But what about Inpatient VS Observation. Any help would be grateful. Thank you.
99241-99201-99211
99242-99202-99212
99243-99203-99213
99244-99204-99214
99245-99205-99215
99251-99221-99231
99252-99222-99232
99253-99223-99232
99254/99255-99223-99233
99221-99218
99222-99219
99223-99220
99231-99234
99232-99235
99233-99236
99238/99239-99217
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A newly Certified Coding Profession ready to jump start my career as a Coding. Over 15 years in clinical and administrated position, treating and mongering various diseases and conditions, medical compliance, auditor and maintain proficiency of a clinical lab. Searching for a position that will lead to a growth of opportunities.
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In the same facility can anesthesia be billed as some rooms being medically directed and other rooms as CRNA independently performed? For example 15 rooms running. Rooms 1-4 directed by a physician, rooms 5-8 directed by a physician and rooms 9-15 CRNA independently performing. I would appreciate your input.
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We are tyring to code out a charge for a revisit to the operating room for a misplaced LC7 lateral mass screw and need some guidance of which ICD 10 code would be most appropriate. The patient originally had a fusion and decompression w instrumentation of C7-T1, T1-T2 due to a trauma. Durring the operation , they were not able ot do any fluorsoscoy because of the patient's large and wide shoulders and so localization and guidance of placement of instrumentation was not possible. The post op CT scan showed the L C7 lataeral mass screw partially within the lateral gutter posterior to the LC7 vertebral body. Based on this finding on the CT scan, the pt was taken back to redirect the LC7 lateral mass screw.
We have coded this charge as:
22849-78
22830-78-51-59
22852-78-51-59
T84.226
Can you please give me your oppinion?
Thank you!
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Pt comes in for depotestosterone every 2-4 weeks. The treatment nurse performs the service. Pt has hypogonadism. Should we code E29.1 and Z79.899 or should the code only be E29.1 which is why the nurse is giving the injection? There is some confusion about the Z79.899 code. We are getting mass amounts of denials asking for chart notes. Any thoughts is greatly appreciated.
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Good afternoon,
We are a pain management specialist's office in Texas. We are seeing new information from insurance companies not authorizing epidural steroid injections unless they are done two weeks apart. We have always done these 1 week apart and never had a problem with Medicare or other commercial carriers paying or allowing these at this frequency. Has anyone heard or seen new information that guidelines are changing for the frequency of these to be done no sooner than 2 weeks apart between injections?
Any knowledge or input you can share on this topic is greatly appreciated. Thank you in advance.
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Why are you using 2 units? What is being documented to justify that? I'm not completely sure, but I thought you would only bill 1 unit for 1 interspace.Originally Posted by susanvega@bellsouth.net
We are getting denials for using two separate levels of nonsegmental hardware across 1 interspace. We are coding 22840 twice and getting denial for one of the codes. Does anyone have any suggestions?
Meagan Strauss, CPC, CEMC
Coding Coordinator
The NeuroMedical Center
Baton Rouge, LA
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The surgeon documents debriding an abdominal wall for a necrotizing soft tissue infection and excising necrotic skin and subcutaneous tissue. But he does not document excising fascia or muscle.
Would 11005 still be the appropriate CPT code even though it's not documented that muscle or fascia was debrided?
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I'm not sure I follow your question. What aspect of business are you referring to?How are you handing zero charge items that are built into the system for productivity purposes and other operative functions?
Walker Bachman, CPC, CPPM
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Hello all!
I'm having some issues with deciding whether or not to use the wound care codes. Can anyone give me a little detail on these codes. For example below is are notes for wound debridement. Would I go with the codes in the 10000s or would I use the would care codes in the 90000s. Any help will greatly be appreciated.
NAME OF PROCEDURE: Local wound debridement and delayed primary closure.
HISTORY OF PRESENT ILLNESS: This is a 75-year-old female with history of PEG
tube placement with erosion of PEG tube site. She underwent gastrocutaneous
fistula take down and new PEG tube placement earlier in her hospitalization;
however, she has had dehiscence of her wound at the gastrocutaneous fistula
site. This was felt to be amenable to local wound debridement and delayed
primary closure.
DESCRIPTION OF PROCEDURE: Informed consent was obtained from the son and all
questions were answered. The patient was brought back to the operating room
suite and induction of anesthesia with general anesthetic was performed. The
patient was prepped and draped in the usual sterile fashion. A time-out was
then performed, verifying correct patient, site, procedure and signature of
informed consent. The wound was inspected and minimal amount of necrotic
debris was evident at the edges of the wound as well as the base of the wound.
This was sharply debrided using a 10-blade scalpel until fat and a minimal
amount of bleeding was identified.
The wound was then inspected for adequate hemostasis and the decision was made
at that time to proceed with delayed primary closure. PDS suture was used to
close the wounds in a simple interrupted fashion with a total of 6 simple
interrupted sutures being placed. The wound was inspected for adequate
hemostasis and when this was determined to be the case, the procedure was then
concluded. The wound was dressed with Primapore tape. The patient was
withdrawn from anesthetic. The patient was transferred back to the ICU in
stable condition.
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Good Morning,
My Dr. performed a op lap w/right salpingectomy and left partial salpingectomy and evacuation of hemoperitoneum. I used CPT 59151. However, the dx is rt. ectopic pregnancy and intrauterine pregnancy and sterilzation per patient request.
What Dx code would be used for this. I thought it could be O31.8x10 and O00.1, O08.9. Is this correct or would we need to use another code? Please help
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I'm hoping someone can help. I know that 95957, digital analysis of EEG, for epileptic spike analysis, requires additional work by the technologist (approx. one hour) and additional work by the physician (approx. 15-20 min) in order to bill this code. My question is: what specific documentation needs to be in the report/medical record that would support/substantiate the extra work done by the tech and MD?
Any assistance will be much appreciated! Thank you!
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Good morning-
Can anyone tell me if it's appropriate to bill these two Meningitis vaccines together since they do not have the same componets? The 90621 is for the Trumenba strain and the 90734 is for the Menactra strain.
I don't see any information in the CPT book to help me with this and I can't seem to get a clear answer when I googled the question.
Thank you!
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HELP!!! 
THANKS!!!
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I see a lot of observation accounts for chest pain with varies associated symptoms. Normally I just see documentation that ACS is ruled out and little detail about what caused the event.
Example: Substernal Chest Pain, N/V, SOB, Diaphoresis, and Jaw Pain. Chronic conditions include HTN and Hyperlipidemia.
Would I be correct to code R072, R112, R0602, R61, R6884, I10, and E785?
Or should the symptoms be coded in the Reason for visit field?
Thank you in advance!
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I like Practicode as it is providing me with actual coding experience. But there are issues with the program. On numerous occasions I had all the correct coding entries but the program scored me incorrectly. For example, on this last chart all six parameters were correct but the program scored me 4 out of 6 and not 6 out of 6. Also, there are inconsistencies in the coding. Anybody else experiencing similar problems?
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POSITION OPENING:
Orthopedic office needs a Certified Coder/Certified ICD-10 with experience in orthopedic billing office practices, E/M coding guidelines, in-office procedures. Understanding of A/R collections is a plus. Please send resume's to gheredia@ctoamg.com.
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Hi,
Wondering how you would code for a replacement of spinal instrumentation screw? This was a broken screw. No plates or rods were replaced or adjusted. Just replacement of the broken screw. The re-insertion code 22849 seems a bit much for just replacing a screw. I was also looking at 20680 "removal of a pin, screw, rod or plate", and does not include replacement. Does anyone have another suggestion?
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Posting for a friend, because this is outside of my area of expertise.
If Dr. X does a Tracheostomy 31600 and PEG 43246 (see copy of op note below) Which code do I bill first and put a mod 59, correct?
31600
43246 – 59
or
43246
31600 – 59
DESCRIPTION OF PROCEDURE:
After having obtained informed consent, the patient was taken to the operating room, placed on the operative table in the supine position. After placement of appropriate monitoring lines general anesthesia was induced. Appropriate timeout was taken. The neck was extended as well as possible and the neck and upper chest were prepped and draped in a sterile fashion. A transverse 2-2.5 cm incision was made, carried down in the midline onto the pretracheal fascia. The cricoid cartilage was identified, second and third tracheal rings were then identified. The tracheal hook was placed just below the cricoid to elevate the trachea. At this point, in coordination with Anesthesia, a cruciate tracheostomy incision was made between the second and third tracheal rings and the stoma was dilated up to fit a #8 Shiley tracheostomy tube. The endotracheal tube was withdrawn under direct vision just above the tracheostomy site and the #8 Shiley extra-long proximal tracheostomy tube was placed. The balloon was inflated. Good ventilation was demonstrated. The catheter was suctioned. The tracheostomy tube was sutured into place. At this point then the patient was intubated orally with the gastroscope, which was passed under direct vision in the proximal esophagus. No esophageal abnormalities were encountered. Inspection of the gastric lumen revealed some mild linear gastritis, previous scarring from previous PEG tube. No other significant abnormalities identified. At this point, the gastric lumen was insufflated externally. The previous PEG tube site was demonstrated with good indention into the gastric lumen. The gastric wall was unable to be transilluminated through due to her significant obesity. At this point, the abdominal wall was prepped and draped in a sterile fashion. Local anesthesia, 1% lidocaine was placed and a small incision was made at the previous site. The 18 gauge needle was then used and passed directly into the gastric lumen over a short distance and extubated in the gastric lumen near the previous PEG tube scar. At this point then a PTFE guidewire was passed through the needle, grasped with the endoscope and brought out orally. The Bard 20 French PEG tube was placed over the guidewire and using push-pull method was brought out through the anterior abdominal wall. The gastroscope was replaced and the PEG tube was noted to be well seated, no bleeding encountered. The PEG tube was at 6 cm at the skin level. The PEG tube was secured, dressing was applied. Patient was then taken to the PACU.
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My billing department has submitted a claim for 90837 with dx 309.81 to Humana (dos 07/31/15). It was rejected, reason being dx309.81 is not a supported dx for cpt 90837. We submitted the medical record to Humana and it was again rejected, reason being the notes did not support the dx with the service billed. What can we do? Is 309.81 not a supported dx for cpt 90837?? Any help is appreciated.
Thank you.
Susan M
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I know that in certain cases we can bill for visits with a patient's family members without the patient present, but... when a patient has already discussed surgery with the doc, but wants to come back with their spouse, or other relative, to have the doctor explain it to them too, would this be considered medically necessary? I was under the impression that this is only done if the patient is a child, or incapacitated in some way. We're talking about fully functioning adults here, and the "decision for surgery" has already been made.
Does anyone know of some reference or guidance on this?
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Job Opportunity - Long Island, NY - NOT REMOTE
IV Medical Services is looking to fill multiple positions with experienced self-motivated medical billers, coders and follow-up personnel with the desire for a stable long-term career. We are a growing multi-office healthcare company that is offering an excellent opportunity for the right candidate to act as an account manager in our Hauppauge, NY office responsible for the end to end billing process for our clients.
Job responsibilities include, but are not limited to:
* coding
* charge entry
* postings
* follow-up including working denials and writing appeals
* credentialing
* communication with clients
Qualifications:
* MINIMUM THREE (3) years experience
* ability to handle multiple accounts
* strong communication skills
* ability to work in a team environment
* strong computer skills including working with various billing programs as well as word processing and spreadsheets
* strong organization skills
* bilingual - Spanish/Korean
*SURGICAL BILLING especially ORTHOPEDICS, Pain Management, OBGYN, DERMATOLOGY, DETOX & Substance Abuse, Behavioral Health, Laboratory Billing and ARTICLE 28 billing are a big plus
Contact: cscohen@ivmedical.us
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Pre/Post Op Dx: Right hip posterior superior labral tear.
Primary Surgeon billed: 27033
Assistant Surgeon insists we also bill an unlisted 27299 for the labral repair
Report is as follows:
At this juncture, a direct lateral incision made centered over the tip of the greater trochanter was outlined in the skin. Skin was incised sharply and deeper dissection was carried out with Bovie cautery down to the IT band which was incised in line with the fascia. A Gibson modification of the approach to the hip was performed and the gluteus maximus was reflected posteriorly.
The extensive bursectomy was performed. The piriformis tendon was identified and the interval developed between the piriformis tendon and the gluteus minimus up to the stable portion of the troch, posterior margin of vastus lateralis and dissected free, and the planned trochanteric osteotomy outlined with the Bovie cautery. The trochanteric osteotomy was then performed with a sagittal saw. The bleeding cancellous base was packed with wax. {27033}
Continued exposure was then performed of the hip capsule superior to the pyriformis underlying the gluteus minimus anteriorly beneath the rectus. Once appropriate exposure was achieved, a Z-capsulotomy was performed of the hip capsule. The hip was then subluxated and ligamentum teres was taut. This was then cut, which allowed a complete dislocation. {I thought he should code a 27036}
Overall, the chondral surface of the femoral head was intact, as was within the labrum.
Two tears of the labrum were noted, both posterior and superior; one at the 11 o'clock position, and one at the 10 o'clock position. These were both repaired with Mitek sutures. Knots made extracapsular. The hip was then reinspected and no additional labral pathology identified. {AS wants to use Unlisted 27299}
No osteochondral issues were concerned. The head was relocated and irrigated. Capsule repaired with #1 Vicryl suture. After repair of the capsule, the trochanter was repaired to its origin with two 3.5 mm fully threaded screws, one 55 mm and one 50 mm in length. Wound was then again irrigated and 0 Vicryl suture used for the IT band. Deeper tissues were closed with 2-0 Vicryl, 2-0 V-Loc, and then the skin closed with 3-0 Vicryl in a subcuticular Monocryl stitch, dressed with Steri-Strips, Xeroform, 4 x 4, Tegaderm dressings. The patient was then awakened from anesthesia in stable condition.
(I added the italics)
**Here's my argument against using the unlisted code: if they had started the arthrotomy and found the tear that needed to be repaired, the unlisted procedure is warranted. But since they knew going in to the arthrotomy they were going to repair the joint along w/ the tear, I don't see how we can justify the unlisted code.
Any other thoughts?
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I am attempting to assist an M.D. that has an established "innovative medical care" practice that is going to incorporate seeing patients for their medical marijuana card. This is considered legal in the state of Illinois. They currently do cash pay patients only at a flat rate. He has been informed that filing claims through the patients' insurance company will maximize his revenue. I agree HOWEVER after much investigation, it appears that no insurance companies are paying for this service, even though it is legal in the state.
My questions are: if they have previously seen the patient, regardless if the patient paid cash or not and they come in for a follow up, the patient is still considered an "established" patient, correct?
Would it be possible to charge a preventative visit 99381-99397 along with an E&M IF an abnormality is encountered and addressed during this preventative visit? I say yes but wanted someone to confirm or deny.
I am concerned because insurance is not currently covering this service yet he has been told by another physician to simply NOT include the drug dependence & or long term use. Based on what I know, this is withheld information and the insurance company could easily come back and recoup their money not to mention what all else.
I have read that some employees have been fired because of the so called new legal program. It is coinciding with their company policies of random drug testing and have been found to have marijuana in their systems!
I want to have full knowledge of this before I move forward as I have worked too hard to obtain and keep my certification in good standing.
Any help would be greatly appreciated.
Thank you
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I am attempting to assist an M.D. that has an established "innovative medical care" practice that is going to incorporate seeing patients for their medical marijuana card. This is considered legal in the state of Illinois. They currently do cash pay patients only at a flat rate. He has been informed that filing claims through the patients' insurance company will maximize his revenue. I agree HOWEVER after much investigation, it appears that no insurance companies are paying for this service, even though it is legal in the state.
My questions are: if they have previously seen the patient, regardless if the patient paid cash or not and they come in for a follow up, the patient is still considered an "established" patient, correct?
Would it be possible to charge a preventative visit 99381-99397 along with an E&M IF an abnormality is encountered and addressed during this preventative visit? I say yes but wanted someone to confirm or deny.
I am concerned because insurance is not currently covering this service yet he has been told by another physician to simply NOT include the drug dependence & or long term use. Based on what I know, this is withheld information and the insurance company could easily come back and recoup their money not to mention what all else.
I have read that some employees have been fired because of the so called new legal program. It is coinciding with their company policies of random drug testing and have been found to have marijuana in their systems!
I want to have full knowledge of this before I move forward as I have worked too hard to obtain and keep my certification in good standing.
Any help would be greatly appreciated.
Thank you
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CERTIFIED PROFESSIONAL CODER/BILLING MANAGER
OBJECTIVE
Seeking a position in which I can utilize my highly skilled, knowledgeable, and proficient medical billing experience. This experience includes extensive, specialized knowledge in management, medical coding, collections, patient accounts, and customer care capacities throughout inpatient/outpatient and independent medical billing environments. I am a highly articulate and effective communicator with demonstrated ability to build new relationships and drive momentum among peers and colleagues.
SKILLS
Medical Coding CPT/ICD9/HCPCS/ICD-10 EDI Transmitting Insurance Verification/Eligibility Authorizations/Pre-certs
A/R Collections/Appeals Pt Letters/Grievances
Payment Posting Monthly Close-outs Customized Reporting HR duties (Payroll, hiring, etc)
Familiar w/ Billing Rules/Regulations in multiple states including but not limited to TX, NY, CA, FL
EMPLOYMENT HISTORY
Surgical Notes, Certified Coder, Remote 12/15-Present
Remote ASC Coder, currently coding for multiple ASCs in different states for a variety of centers who facilitate services to all specialties that include but are not limited to General Surgery, ENT, OBGYN, Pain, etc. Must maintain accuracy, consistency, and timeliness with all cases presented.
Exact Billing Solutions, Billing Manager, Houston, TX 2005-12/2015
Duties have shifted throughout the years, currently the lead coder for the following specialties: Family Medicine, Internal Medicine, General Surgery, Bariatric Surgery, Gastroenterology, Gynecology, Pediatric Infectious Disease, Neurology and Neonatology.
NueMD, Billing/Collections/Posting, Remote 2014-Present
Duties for this position include posting payments and collections for multiple specialties. Previous duty included Pain Management coding.
The Pain Care Center, Houston, TX 2004 – 2005
Ran the back office, duties included: prior-auths for outpatient procedures, surgery scheduling, MA work, and patient counseling.
Bear Creek Wellness Center, Houston, TX 2002 – 2004
Front office coordinator: Responsible for scheduling, pt check-in, collecting copays, insurance verification and referrals.
Oscar De Valle, MD, Houston, TX 1999 - 2002
Back office coordinator: Triaged patients, completed prescription refill requests, helped with procedures, administered injections, phlebotomy, and scheduled procedures.
COMPUTER SKILLS
Microsoft Office LeonardoMD (web-based)
Medisoft NueMD (web-based)
Medical Manager E-Clinical Medicare ERA software Clearinghouses (Availity/Ingenix/Optum/Navicure) Quickbooks typing 50 wpm 10 key by touch Encoder Pro
PROFESSIONAL EXPERIENCE
CODING
Responsible for CPT/ICD-9/HCPCS/ICD-10 coding for multiple specialties including but not limited to internal medicine, general surgery, emergency room, pain management, infectious disease, gastroenterology, colon/rectal, otolaryngology, obstetrics/gynecology and neonatology.
• Primary coder for over 5 accounts at a time for various specialties; both inpatient and outpatient
• Oversee other coders by performing audits and system checks to ensure accuracy
• Keep up to date with current changes and updates regarding codes/bundling
A/R COLLECTIONS/APPEALS
Use online/phone resources to ensure that all claims going out are not only paid in a timely manner, but also that they have been paid at the correct reimbursement rate allowed by contract.
• Extensive experience and understanding of Medicaid and its Commercial plans
• Extensive experience and understanding of Medicare and its Supplement and HMO plans
• Familiar with Texas State Laws that can be used to ensure timely payments for commercial payers
• Work A/R in its entirety monthly with no exception (to avoid PTF issues)
• Experience in helping guide the patients and to help them understand what their rights are recommendations to secure payment from their insurance carrier
H/R DUTIES
Responsible for keeping track of all employees and their daily activities
• Semi-monthly payroll which includes counting up hours, recording time-off, and accessing Quickbooks
• Daily/weekly audits on individual employees and the completion of their daily tasks
• Interviewing/Hiring/Terminating of employees when necessary
• Creation/updating of policy/procedures such as Handbooks as necessary
MONTHLY CLOSE-OUTS
Generate all reports and correspondence that is required to reconcile at month end
• Balance the month end deposit report from the practice management system to the lockbox total
• Run monthly reports to keep track of vital information such as total billed, collected, and outstanding
• Run clean A/Rs for the next months collection work
• Keep track of payer mix reports, procedure analysis, and other customized reporting necessary to project future revenue
EDUCATION
NHMCCD, Associate of Arts – Field of Study, Business, Houston, TX 2007
Jersey Village High School, Houston, TX 2000
Bilingual – Speak, Read, and Write Spanish
CERTIFICATIONS
Certified Outpatient Coder, AAPC awaiting testing
ICD-10 Profecient, AAPC 2015
Certified Professional Coder, AAPC 2011
Certified Medical Coder, PMI (Practice Management Institute) 2010
Dale Carnegie Course: Effective Communications & Human Relations/Skills For Success 2009
REFERENCES UPON REQUEST
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CERTIFIED PROFESSIONAL CODER/BILLING MANAGER
OBJECTIVE
Seeking a position in which I can utilize my highly skilled, knowledgeable, and proficient medical billing experience. This experience includes extensive, specialized knowledge in management, medical coding, collections, patient accounts, and customer care capacities throughout inpatient/outpatient and independent medical billing environments. I am a highly articulate and effective communicator with demonstrated ability to build new relationships and drive momentum among peers and colleagues.
SKILLS
Medical Coding CPT/ICD9/HCPCS/ICD-10 EDI Transmitting Insurance Verification/Eligibility Authorizations/Pre-certs
A/R Collections/Appeals Pt Letters/Grievances
Payment Posting Monthly Close-outs Customized Reporting HR duties (Payroll, hiring, etc)
Familiar w/ Billing Rules/Regulations in multiple states including but not limited to TX, NY, CA, FL
EMPLOYMENT HISTORY
Surgical Notes, Certified Coder, Remote 12/15-Present
Remote ASC Coder, currently coding for multiple ASCs in different states for a variety of centers who facilitate services to all specialties that include but are not limited to General Surgery, ENT, OBGYN, Pain, etc. Must maintain accuracy, consistency, and timeliness with all cases presented.
Exact Billing Solutions, Billing Manager, Houston, TX 2005-12/2015
Duties have shifted throughout the years, currently the lead coder for the following specialties: Family Medicine, Internal Medicine, General Surgery, Bariatric Surgery, Gastroenterology, Gynecology, Pediatric Infectious Disease, Neurology and Neonatology.
NueMD, Billing/Collections/Posting, Remote 2014-Present
Duties for this position include posting payments and collections for multiple specialties. Previous duty included Pain Management coding.
The Pain Care Center, Houston, TX 2004 – 2005
Ran the back office, duties included: prior-auths for outpatient procedures, surgery scheduling, MA work, and patient counseling.
Bear Creek Wellness Center, Houston, TX 2002 – 2004
Front office coordinator: Responsible for scheduling, pt check-in, collecting copays, insurance verification and referrals.
Oscar De Valle, MD, Houston, TX 1999 - 2002
Back office coordinator: Triaged patients, completed prescription refill requests, helped with procedures, administered injections, phlebotomy, and scheduled procedures.
COMPUTER SKILLS
Microsoft Office LeonardoMD (web-based)
Medisoft NueMD (web-based)
Medical Manager E-Clinical Medicare ERA software Clearinghouses (Availity/Ingenix/Optum/Navicure) Quickbooks typing 50 wpm 10 key by touch Encoder Pro
PROFESSIONAL EXPERIENCE
CODING
Responsible for CPT/ICD-9/HCPCS/ICD-10 coding for multiple specialties including but not limited to internal medicine, general surgery, emergency room, pain management, infectious disease, gastroenterology, colon/rectal, otolaryngology, obstetrics/gynecology and neonatology.
• Primary coder for over 5 accounts at a time for various specialties; both inpatient and outpatient
• Oversee other coders by performing audits and system checks to ensure accuracy
• Keep up to date with current changes and updates regarding codes/bundling
A/R COLLECTIONS/APPEALS
Use online/phone resources to ensure that all claims going out are not only paid in a timely manner, but also that they have been paid at the correct reimbursement rate allowed by contract.
• Extensive experience and understanding of Medicaid and its Commercial plans
• Extensive experience and understanding of Medicare and its Supplement and HMO plans
• Familiar with Texas State Laws that can be used to ensure timely payments for commercial payers
• Work A/R in its entirety monthly with no exception (to avoid PTF issues)
• Experience in helping guide the patients and to help them understand what their rights are recommendations to secure payment from their insurance carrier
H/R DUTIES
Responsible for keeping track of all employees and their daily activities
• Semi-monthly payroll which includes counting up hours, recording time-off, and accessing Quickbooks
• Daily/weekly audits on individual employees and the completion of their daily tasks
• Interviewing/Hiring/Terminating of employees when necessary
• Creation/updating of policy/procedures such as Handbooks as necessary
MONTHLY CLOSE-OUTS
Generate all reports and correspondence that is required to reconcile at month end
• Balance the month end deposit report from the practice management system to the lockbox total
• Run monthly reports to keep track of vital information such as total billed, collected, and outstanding
• Run clean A/Rs for the next months collection work
• Keep track of payer mix reports, procedure analysis, and other customized reporting necessary to project future revenue
EDUCATION
NHMCCD, Associate of Arts – Field of Study, Business, Houston, TX 2007
Jersey Village High School, Houston, TX 2000
Bilingual – Speak, Read, and Write Spanish
CERTIFICATIONS
Certified Outpatient Coder, AAPC awaiting testing
ICD-10 Profecient, AAPC 2015
Certified Professional Coder, AAPC 2011
Certified Medical Coder, PMI (Practice Management Institute) 2010
Dale Carnegie Course: Effective Communications & Human Relations/Skills For Success 2009
REFERENCES UPON REQUEST
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I am having some issues with the revisions denying for the LCD/not medically necessary when we have used a diagnosis listed in the LCD (and documented in the op note, of course).
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POSTOPERATIVE DIAGNOSES:
1. Retained painful hardware, right elbow, distal humerus.
2. Right elbow contracture, status post open reduction and internal
fixation of grade 2 open distal humerus fracture.
3. Delayed union right distal humerus.
PROCEDURES PERFORMED:
1. Removal of retained screw, right distal humerus.
2. Manipulation of right elbow under anesthesia.
3. Debridement and bone grafting for right distal humerus, medial column
delayed union.
Attention was turned to the right elbow. The previous incision was utilized.
Sharp dissection through skin was followed by blunt dissection through
subcutaneous tissues. Bleeding was controlled with Bovie electrocautery and
direct pressure. Care was taken to protect neurovascular structures
throughout the approach. There was significant adhesive tissue involving the
triceps through the zone of injury. Adhesions were released and tenolysis
performed and the triceps was carefully mobilized. The ulnar nerve was
palpated in its anteriorly transposed position. There was no significant
scarring or adhesions around the nerve through the visible and palpable
areas. It was stable in its transposed bed. The medial column plate was then
exposed at the apex of the epicondyle.
Preoperative evaluation showed that the third screw from the distal end was
the problematic screw with interference in the radiocapitellar joint. Once
this screw was fully exposed, it was removed without significant difficulty.
The elbow was taken through a gentle range of motion. Preoperatively, the
patient only had about 80 degrees of active flexion. I was able to achieve
nearly 110-120 degrees of flexion with gentle manipulation. Supination and
pronation also were improving from his preoperative status with nearly 70
degrees of achieved full supination. Adhesions were released and good motion
was achieved. No other releases were deemed necessary at this point. The
medial column was then further exposed and there was some bridging bone at
the area of the plate; however, there was gapping and fibrous union
developing along the more central aspect of the medial column. This was
carefully debrided with a curette.
The column was noted to be stable, and no other fixation was deemed
necessary. Evo3 bone graft was then placed into the bone void to help
promote further healing at this site. The elbow was taken through range of
motion again and noted to be stable. The wound was copiously irrigated. The
tourniquet was deflated. Hemostasis was achieved. The medial window at the
triceps was reapproximated with Vicryl suture, and the skin was closed in a
layered tension-free fashion. A sterile postoperative dressing was applied.
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Procedure performed: Excision of bladder adhesions
Patient was undergoing a hysterectomy, however the patient had an extremely adhesed uterus to the bladder. My physician was called in and was able to slowly dissect off the uterus from the bladder, leaving only a a small piece of uterus attached to the bladder. The uterus was removed and the hysterectomy was finished by the other physician.
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I need some assistance in where to obtain the documentation requirements for a well woman exam. One of our providers performed stated she performed a well health exam (99387) with pap with the diagnosis code Z01.419 routine gyn exam without abnormal findings; however the physical exam part was very small. I am concerned that this would not meet the physical exam portion of a well woman exam and I am trying to find the specific documentation requirements for the physical exam portion. Patient has a commercial insurance. Can someone please provide me with a link or area where to find these guidelines? The American college of Obstetricians and Gynecologists (ACOAG) is kind of vague on this. If anyone can assist me or give me a link to what exactly is needed for the physical portion of the exam I would truly appreciate it.
Thank you so much,
Lorri
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I have a new Provider that is a Do. She is nder the inpression that when she charges for her OMT procedure, that she atuomatically can charge the 99214 code as she says that all her colleages bill their OMT visits out this way. The CPT code book does state that an E&M code can be charged out with the 98925-29 codes if the patients condition requires a significant seperately identifiable E/M service above and beyond the usual preservice and postservice associated with the procedure. My provider states that every time she does an OMT procedure she has to decide then how to treat for the problem and that everytime both an E/M code and OMT code should be used.
Can anyone elaborate on this for me. as when I read the cpt code description, I see it as the E/M is included in the procedure unless there is something more going on.Thanks in advance for your help with this
Kelly Blanch CPC
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I am working on an audit and am not familiar with billing for critical access hospitals. A patient is admitted for five days and is seen by three different hospitalists. All five encounters are billed
under the discharging physician. Is this correct? I am used to the good old way where the physician that sees the patient bills.
Thank you
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I'm currently working in a new hospital. How do we bill for the patients in ER, who just got admitted as inpatient, but cannot be transferred to the ward/regular room yet due to unavailability of room? I was informed that we cannot bill a regular room (i.e. Med Surg rate) if the hospital capacity is at its maximum. Some suggested terminologies such as ER-holding or ER-overflow...but we don't have details on how to set the codes for billing.Thank you for your feedback.
Marites
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My name is Felicia. I will be taking my CPC exam on April 16, 2016 here in Lewiston, Maine. I am new to this chapter and new to coding. I have no one in my network and would like to start building it! I am very excited to become certified and start my career in medical coding!
PRACTICODE!! Has anyone completed a Practicode program? I will be starting that next week so I can have the two years experience on my resume!
Any advice of tips would be greatly appreciated!
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INDICATIONS: This is a young patient, who after cath and Angio-Seal developed claudication and was found to have total occlusion of the distal external iliac artery with collaterals reconstituting the common femoral artery via the internal iliac artery.
DETAILS OF PROCEDURE: Informed consent was obtained. The patient was brought to the cath lab. Left groin was prepped and draped in the usual fashion. Xylocaine 2% was infiltrated to obtain local anesthesia. Cannulization of the left femoral artery was obtained using modified Seldinger's technique on first attempt and size 6 sheath was introduced. A 6-French internal mammary artery catheter was then advanced across the bifurcation and angiogram was done. The patient was documented to have 100% occlusion of the distal external iliac artery and the entire external iliac artery had very diffuse narrowing.
The internal iliac artery was giving collaterals and reconstituted the common femoral artery.
Interventional procedure was started. The patient was given 5000 units of heparin intra-arterially and a 6-French crossover sheath was used. Then, a 5-French glide catheter was used and the occlusion was attempted to cross first with a 0.018 V18 wire. It did not cross. We then used a 5-French glide catheter and tried the Storq wire, which did not cross the occlusion. Then, used a Miracle Bros 6 guidewire and that was able to cross the occlusion. The glide catheter was then advanced over the wire and angiography done to make sure that I was in the true lumen. The PTA procedure was started. The occluded segment was dilated with a 5 x 6 balloon. Angiography was done and showed improvement. After careful review of the film, it was decided to stent the proximal CFA and external iliac artery with a 7 mm x 10 cm Viabahn stent .The 6 F cross over sheath was exchanged with 7 F sheath Wire was exchanged with 0.18 wire. Viahban stent was advanced and very carefully positioned and deployed. The proximal external iliac artery was stented using a 7 x 57 balloon expandable stent and both stents were overlapped. The stented segment was then dilated with the same balloon. Balloon was removed. Angiography revealed very good result with no residual stenosis. The patient had no complications. The 7-French crossover sheath was then exchanged with a 7-French short sheath, Procedure was completed. The patient was sent to recovery area in stable condition for sheath to be removed once ACT down. She had no complications
is it:
36140
37221
37223-22,51,XU
75716
thanks!!!
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